‘Whatever it takes’: Hospitals get creative in hiring nurses amid a national shortage

That’s what Doug Mitchell realized after becoming the chief nursing officer of WVU Medicine in late 2015. Early on, he had to hire 200 nurses to staff the nonprofit health system’s new $200 million expansion of its Heart and Vascular Institute. Traditional incentives — signing bonuses, overtime pay, flex scheduling — were all on offer. But they weren’t cutting it.

“Morgantown is a delightful place, but a lot of times, when people outside the state think about West Virginia, there’s a negative connotation,” Mitchell said. So WVU Medicine tried an additional tactic: free accommodations. For job applicants from out of town who didn’t want to relocate, the hospital leased a 44-bed dorm and began offering it free of charge to long-distance commuters.

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So far, several hundred nurses — including ones from Ohio, Pennsylvania, and Maryland — have stayed at the dorm before returning home.

Hospital administrators, long accustomed to the world of hiring incentives, are making more enticing offers to nurses than ever before. Five-figure signing bonuses have replaced four-figure ones. One Texas health system dangles the prospect of free nursing degrees to train existing staff or volunteers as nurses, while a Missouri health system offers an enticing loan forgiveness program. A Kentucky hospital even gave new nurses who came aboard a chance to win a 2017 Ford Mustang convertible.

By 2022, the American Nursing Association predicts the U.S. may need more than 1 million new nurses to both care for a growing number of older Americans and replace retiring nurses. Nursing schools, citing their own shortage of teachers, each year are being forced to reject tens of thousands of qualified applicants from baccalaureate and graduate nursing programs.

“The incentives speak to the severity of the shortage,” said Alexi Nazem, co-founder and CEO of Nomad Health, a tech startup working to address the national shortage of medical practitioners. “But hospitals aren’t just trying to solve the problem of a shortage, but also of turnover. It’s hard to hire. It’s also hard to retain people.”

All of this has happened amid a shift in the profession: More inpatient nurses are flocking to outpatient work — leaving hospitals with a desperate need for staff to care for the rise in patients in the era of Obamacare. The end result is that some hospitals have cut back on available beds, or even shuttered full hospital units, as was the case for one Nebraska hospital in early 2017.

Issues driving the shortage

Pikeville Medical Center, in eastern Kentucky, saw its need for nurses boom after expanding last year into a 320-bed hospital. It was already hard to hire nurses. So administrators offered a $25,000 signing bonus — as compared to the bonuses of $5,000 to $10,000 many hospitals offer these days — and the convertible giveaway. There was a catch: Nurses had to sign a five-year contract and would receive the bonus incrementally over that time. But spokesperson Kevin McIver says Pikeville Medical Center now has around 700 nurses.

“[It] helped us recruit over 300 qualified nurses at a time when other hospitals were experiencing dire shortages due to the national nurse shortage,” he said.

As educational standards for nurses have changed, tuition fees can also be an attractive perk for job applicants.

Several years ago, Irving-based Medical City Healthcare launched Texas 2-Step — an education initiative that would allow employees and volunteers of the 13-hospital system a chance to earn a free associate degree in nursing. Employees must agree up front to work for two years as a registered nurse at one of the system’s facilities. Jenifer Tertel, vice president of human resources at Medical City Healthcare, said the program has trained over 300 nurses and 80 percent are still with the organization.

“This is the biggest part of our workforce,” Tertel said. “We want to give [employees] every opportunity to grow and develop as a nurse. In providing for our own nurses, we believe that drives better care for our patients.”

Still, some nursing experts believe these sorts of hiring incentives fail to address the underlying issues driving the nursing shortage. Seun Ross, director of nursing practice and work environment for the American Nurses Association, said incentives like these are a stopgap for rural regions with few other options. And in metro areas, she said, hospitals “pilfer” nurses from competitors, resulting in “the same nurses shuffling back and forth” without the overall number increasing much.

Instead, Ross thinks the focus should be placed on boosting resources available to nursing schools so they can hire more teachers who, in turn, can train more students. She also said hospitals must invest in the experience of nursing — buying cutting-edge equipment and cultivating an inclusive work culture — in order to get the most out of their nurses.

“If you invest in nurses with signing bonuses, you might keep them a few years, but they’re going to leave if the work environment sucks,” she said. “If you invest in nurses already there, they’re going to bring their friends.”

Mitchell believes doing both — incentives for nurses up front and investing in the practice of nursing — is the best way to move forward. In the case of WVU Medicine’s leased dorm, traveling contract nurses get an extra perk that lets them feel well-rested, potentially improving on-the-job performance. And for some nurses, staying in the short-term opened their eyes to Morgantown’s small-town charm. At least eight nurses have gone on to rent apartments or buy homes there to move closer to a job they enjoy.

“The incentives let someone give you a try,” Mitchell said. “But you keep nurses around, not through incentives, but by treating them well and staying true to your mission. We have to do whatever it takes to fulfill our mission as a not-for-profit hospital.”

After reading your article on the shortage of Nurses, I have two questions. Is Doug Mitchell still in need of Nurses at WVU? Are they still offering free Dorms and signing bonuses? I am a LPN from NY with a BA, looking for an upgrade and change. How can I make contact.

The bottom line is greed, not nursing shortage.
I’ve worked in several states, in different capacities and the common thread
is there. Whether it is hospital based issues, (ICU/step-down/floor nursing), HHRN, hospice, or WAH nursing such as Case Management, Utilization Review, etc., “care” and “quality” have been replaced with:
1. metrics
2. patient surveys
3. lower pay for experienced nurses vs new grads
4. difficulty advancing career/education d/t cost vs benefit after cost
(low return for money spent)
5. corporate cultures stating one thing, but management allowed to bully,
harass and over work nurses with completely unreasonable expectations
6. view those who speak up/advocate for themselves and the patient as the
“problem” employee; regardless of professionalism issues/barriers
are addressed and even when offering solutions to barriers
7. nurses are leaving all areas of health care because we just cannot stand
being treated unfairly, irrationally placed demands/expectations while
management refuses to own their part and for money. Greed causing too
much work that requires over-time as a norm, not an occasional event.
8. nurses resent management receiving bonuses that they receive from the
hard work that their nurses did for them and bonuses/raises/lack of resources continue to run rampant.
9. I agree w/the author here. Treat nurses (and all employees for that matter) w/respect, gratitude that is reflected in actions not just platitudes.
10. If that happened, nursing jobs would be so competitive you couldn’t get
one because everyone wanted to work instead of wanting to run out the
door.
-Just my thoughts.

I have never taken a job as a nurse, because of a bonus offered. The bigger the bonuses, the bigger the red flags to me, in regards to the facility. Why are they having such troub that they have to bribe new nurses to come? What do the locals know that those from elsewhere do not? What deep dark secret of awful workplace culture lurks on the other side of that bonus?

Create cultures of teamwork, accountability, equality, and provide support for your staff in education, advancement, changing specialties, addressing burnout, and creating good work-life balance. Pay your nurses enough that they can afford self care, and offer some too. (Nice workplace gym? Onsite childcare for employees at an affordable rate? Good insurance? Uniform stipends?)

Create a place we want to work, and we will come. Try to attract us and do bait and switch? And you will be burned, because nurses have friends and we share that information.

Just a thought, grandfather seasoned LPN’s to RN’s and lessen the shortage instantly. Most facilities, LPN’s have a assigned team just as the RN’s do. Years ago LPN’s were grandfathered in to accommodate nursing shortage.